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General NPI Number Information
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NPI Number | 1770524258
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Entity Type | Individual
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Provider Name | CARMEN LEAH JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 BUNKER HILL DR
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City | AITKIN
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State | MN
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Zip | 56431-1865
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Country | US
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Telephone | 218-927-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 315 N OAK BEND DR
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City | DULUTH
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State | MN
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Zip | 55811-5223
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Country | US
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Telephone | 218-729-8883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 44732
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License Number State | MN
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